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A photograph of the calf was taken before the treatment. and thigh. The small saphenous vein is also a large vein
After the first passage, it is necessary a pretreatment that runs subcutaneously along posterior leg. Accidental
evaluation with the design on the skin of the interested injury to saphenous veins leads to noticeable hematomas
area and this is an important passage because it’s and blood infarction of the implant with possible
where anesthesia has got to be performed before infection.
the intervention. Later, 2.5 mL of preprepared local
anesthesia mixture is injected into the subcutaneous Technical pearls [Figures 3–5]
space maintaining 2 cm apart between the injection It is important to identify the saphenous vein using visual,
points. tactile, and echographic examination to design the course
of saphenous vein prior to injection.
An 11 blade is used to make a small skin incision for
insertion of cannula. Scissors are used to create a tunnel In the subcutaneous space, the cannula should be
through the incision. Then, the cannula is inserted into directed superficial to superficial muscularis fascia of
the tunnel, and ultrasound guidance is used to navigate gastrocnemius in order to have a better management
dissection through the subcutaneous space to reach the of the distribution of the filler and to avoid the rapid
treatment area. The HA is delivered to the subcutaneous reabsorption of the material. The point and area of
space through the cannula in a retrograde technique. injection must be decided according to the defect that
Another tunnel is created through the same incision has got to be corrected.
by changing the angle of the cannula [Figure 1]. This Complications
procedure is repeated until HA is uniformly filled in Hyaluronic acid does not have tissue specificity and has
the desired location. A total amount of 30 mL of HA minimal risk for allergic reactions when injected. However,
is delivered to each calf. Then, massage is performed the degree of complications increases when large volumes
and in the skin incision was closed with up with Vicryl are injected. The complications are divided as early or
5–0 sutures [Figure 2]. Repeated treatments should be late:
needed.
• Early complications are resolved in days to weeks after
After the treatments, the patient had been asked to judge injection and include overcorrection, local infection,
the results using a subjective evaluation scale in which they skin necrosis, herpes reactivation, discoloration, and
were asked to choose their grade of satisfaction between:
very satisfied, satisfied, moderately satisfied, and unsatisfied.

Anatomical pearls
The great saphenous vein or the long saphenous vein is
a large superficial vein that runs along medial side of leg

Figure 1: The 15 cm long cannula is used to inject hyaluronic acid
subcutaneously into the calf a b
Figure 2: (a) Before, (b) after treatment

Figure 3: Ultrasound examination of tissues and vessels Figure 4: Ultrasound picture of the vein

Plast Aesthet Res || Vol 1 || Issue 2 || Sep 2014 63